HomeMy WebLinkAbout038-1092-10-100 —_�
Wis onsn Department of Commerce PRIVATE SEWAGE SYSTEM Count St. Croix
Safety and Building Division INSPECTION REPORT Sanitary Permit No: 0
538795
(ATTACH TO PERMIT) State Plan ID No:
GENERAL , NFORMATION
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. parcel Tax No
Permit Holder's Name: City Village X Township
Kralewski, Allen
Star Prairie, Town of 038- 1092 -10 -100
E jj BM Description: Section /Town /Range /Map No:
CST BM Elev: r G�� 22.31.18.379A10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ! [, 4 / Benchmark Z Z (bZ
Dosing Alt. BM. 11 ^ M Z_
� l i-� Co✓�. `)
Aeration Bldg. Sewer 95 9 -7 . 2 5
Holding St/Ht Inlet S !; q l(o , 7
St/Ht Outlet 5 q G L L B
TANK SETBACK INFORMATION /
TANK TO P/L WELL BLDG. Vgnt to Air Intake ROAD Dt Inlet
5 arc
Septic 7 �� 9 / % - Dt Bottom
t!�
Dosing 1 Header /Man. ( QS j
Aeration _ - /
Dist. Pipe -7 . l4
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
`�� �� Z y 165 GPM
Model Number _ -
i
TDH Lift Fri H Ft
Forcemain Length Dia. Dist. to well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches ( J� PIT DIMENSIONS No. Of Pits FInside . Liquid Depth
DIM ENSIONS q4 SETBACK SYSTEM TO d CHAMBE S P/L BLDG WELL LAKE /STREAM LEACHING rer: INFORMATION R OR ., _A
Type Of System: j o / UNIT mber: `
C LatJ2. 6 ��
I -L �`'f
DISTRIBUTION SYSTEM
Header /Manifold �i x Hole Size x Hole Spacing Vent to qHt Intak
Distribution e
Lengt Dia_ Length \ Dia Spacing \
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only _
xx Depth Over xx Depth of 7--seeded/Sodded
Depth Over Mulched
Bed/Trench Center 31 / BedlTrench Edges ` Topsoil Yes [ No Yes No
J Ins Inspection #1: 7 / Z/ / �� Inspection #2: / /__
COMMENTS: (Include code discrepencies, persons present, etc.) P
Location: 2068 & 2070 110th Street New Richmond, WI 54017 (SW 1/4 NW 1/4 22 T31 R18W) m tes & bounds Lot Parcel No: 22.31.1 .379A10
t 1 COJ4 �� a �
l � 4-c. � ZAIio e-^ co
1.) Alt BM Description = 6 a �`J R
�
2.) Bldg sewer length = I 9� W��O
- amount of cover = /i
A4
Plan revision Required? ❑ Yes 50 No
Use other side for additional information. 4Sig natur Ce t. No.
SBD -6710 (R.3/97) Date Insepcto
Safety and Buildings Division County
2 11 W. Washington Ave., P.O. Box 7162 j T. Ue-a
n 1 Madison, WI 37 7 2 Sanitary Permit Number filled in by Co.)
s /t (608) 3
Department f Gomme c e. lJ 1 e. g 7/ J
w State Plan I.D. Number
pplication �,
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, sI5.04(1)(m) Project Address (if different than mailing address)
1. Application Information - Please Print A formation
Property Owner's Name Par # Block #
f
Property Owner's Mailing A dress roperty Location
V %., _AW Section
City, State Zip Code Phone Number
Fmd c
r ' ua� 5TH 63 7 T .3L N; R trele one)
E orb
11. Type of Building (check all that apply)
,�./ Subdivision Name CSM Number cA
NJ 1 or 2 Family Dwelling - Number of Bedroo 4
[I Public /Commercial - Describe Use R
❑ State Owned - Describe Use ` �, (� Z ity_ ❑Village Township of �Q
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System [% Re p lacement System y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System
to
B. ❑Permit Renewal El Permit Revision El Change of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS S stem: Check all that appl
P Non - Pressurized In - Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
Recirculating Synthetic Media Filter El Leaching Chamber El Drip Line El Gravel-less Pipe El Other (explain) r' I)�
V. Dispersal/Treatinent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity n Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing � / G•/
Tanks Tanks t f
Septic or HaLL^g-Tan t
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for instatlation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plu is Signature MP/MPRS Number
1 7- , 1 / hone Number
Plumber's Address (Street, City, State, Zip Code) /
VIII. County /De artment Use Onl
Sanitary Permit Fee (includes Gro dwater Date sueAlssuin t Sign w Stam
><)Irp, I q proved Disapprov Surcharge Fee) s� /1 er Given Reason Denial � IX. Conditions of Approval/Reasons for 'approval 3) O1 Jt+)DE.N.. � G.
SY$T£,MOMER' J Goya - �t w�
1 Septic tank. *Muent filter and 5 � Q�w� 1r6
dispersal cell must all be servkes I maintalned �� ; , .� A. as per management plan provided by pktmbar. A � b j. tie*A" .
2.. iw1 . setback requireme lts must be rnainWled A eJ- 4%
se per spplcable code / ordinatIM.
Attach complete plans (to the Comfy only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: X12 �f l�J SN SQL
Owner's Name: _ &LU f) V_V _ &, J Sb
Owner's Address: at q 1 9 l a , wT
Legal Description:
t
Township: _ r e
County: 5r -X
Subdivision Name:
Lot Number:
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross - Section
Page 4 _ Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenanc Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer /Plumber: 1411 and License Number:
Date: / r Phone Number 5i'6 J 7
Signature
Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01).
Page 1
Q �
Vo
1�
Ar
2
L
O �
S
l �.s
-� � apt
l
Soil Absomd9nl MMIM Cross Section
ft
Final Grade
4° Schedule 40
PVC Vent Pipe
Wdh Vent Cap
Leaching --►
Chamber ♦_ ft
System Elevation
._ ft _3 ft
Soil AbsomOon Systwm Plan mew
ft
1 ft
f -3,
Vent Or Observation Pi Ling Trench 1
!� Chambers
IIIIIIAIIIII 4' Dia.
Trench 2 Header
L eaching C Specifications
Manufacturer And Model r ILL
EISA Ratin �` _ s ft per chamber Soil Application Rate , Z gpolsq ft
_ 3oo gpd Design Flow + r 2 Soil Application Rate + _ EISA = Chambers
2 rows of chambers each.
j Page of
I !
Application: Single family homes not to
exceed three bedrooms and two and 1/2
baths in size.
ZOELLER SEPTIC TANK RISER
Filter Area: 61 Linear Feet of 1116" filtration
i Flaw Rate: 850 gpd.
Material: All materials are noncorrosive in d
the septic tank environment. ourLEr
Fast' to install or retrofit: The Zoeller
Septic System Filter fits inside any 4" sani-
tary tee. Slide the filter cartridge into the FILTER GASKET
4 "SANITARY TEE
sanitary tee at the tank's outlet. The drain
a *NOTE
field is now protected from solids greater d
than 1/16 ".
d
Easy to inaintain. The Zoeller filter should 24"
TOTAL LENGTH
be cleaned each time the septic tank is OF FILTER
4 "DRAINAGE PIPE
pumped. More frequent cleanings will not 6'—
FILTER SLOTS a
hurt the filter and could even improve the
performance of your septic tank. For instal- �®
lations that exceed the design flow rate of '
the filter, more frequent cleanings may be Cg iNCER SKIM
required or manifold more than one sanitary *NOTE: State and local plumbing codes may require
tee to accept more than one filter. a specific liquid penetration. For example, 25 % -45%
into the liquid depth or 9" off the tank bottom.
T:;tti ��a,lkt: Every Zoeller filter is guaranteed to be free from defects in materials and workmanship for
the lifetime of the homeowner /purchaser. Free repair or replacement, excluding labor, will be made on return of
the filter prepaid to the factory. This warranty is limited to product proven to be free from abuse or improper
installation.
ALL ZOELLER ON -SITE WASTEWATER PRODUCTS MUST BE INSTALLED IN ACCORDANCE WITH LOCAL ANDIOR STATE PLUMBING
AND /OR HEALTH DEPARTMENT CODES.
MAIL TO: P.O. BOX 16347
Louis>fe, KY 40256-0347 Manufacturers of. .
t SHIP TO: 3649 Cane Run Road L�, p
® Louisv&, KY 40211 "1961 lJ14"rY 9UMP6 SIM /
PUMP !O. ( 502) 778 - 2731.1(800) 928 -PUMP
http://www.zoelter.com FAX (502) 7744624
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
AL'ti ru �5 _ 42 Septic Tank Capacity d$� gal ❑ NA
Permit # L
7 Septic Tank Manufacturer &J ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer
x,11 &4 03 NA
Fumber drooms Z ❑ NA Effluent Filter Model
❑ NA
blic Facility Units �A Pump Tank Capacity _ ❑ NA
w (average) 6U gal /day Pump Tank Manufacturer
❑ NA
Design flow (peak), (Estimated x 1.5)
O� gal /day Pump Manufacturer ❑ NA
Soil Application Rate 0
gal/day/ft' Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit
Fats, Oil & Grease (FOG) 530 mg /L A
❑ Sand /Gravel Filter ❑Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L - t )S%NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection
❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s)
Biochemical Ox . ❑ NA
Oxyg Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade
❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other:
Other: ❑ NA
❑ NA Other:
❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other:
❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s)
year(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: g jn onth(s)
Jgyear(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: Vmonth(s)
year(s) 0 NA
(s)
Inspect pump, pump controls & alarm At least once every: ❑ ear(s) 1 �yrvA
Y
Flush laterals and pressure test At least once every: ❑ month(s)
Other: ❑ year(s) ❑ NA
At least once every: ❑ month(s)
Other: ❑ year(s) ❑ NA
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER ^n POWTS MAINTAINER
Name 1o.– "Pre Name
Phone -7/5 — (o4(D' ZG Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
E Name �, �d�X
Phone
Phone ,7 Vp_
This document was drafted in compliance with chapter Comm 8 3.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer M I PW k
Mailing Address 10 rY
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City /State S , �' Parcel Identification Number 2,9 , 2 1 J6�!��
LEGAL DESCRIPTION
Property Location %4 %a , Sec. T / N R ' W Town of `
Subdivision Plat: 22 , Lot #
Certified Survey Map # , Volume L , Page #
Warranty Deed # _ (before 2007)Volume , Page #
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes O no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
NATURE OF ICANT(S) D ATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 09/07)
84341Z 3 f �j
STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX Co. WI
This Deed, made between Kenneth A. Hecht, a single person RECEIVED FOR RECORD
Grantor, and Allen L. Kralewski Grantee. 01/29/2007 11: 40AK
Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED
the following described real estate in St. Croix County, State of Wisconsin (the EXEMPT N
"Property") (if more space is needed, please attach addendum): REC FEE: 13.00
TRANS FEE: 390.00
SEE ATTACHED LEGAL DESCRIPTION COPY PEE:
CC FEE:
PAGES: 2
Recording Area
Name and Return Address
Casterton Title & Closing Company, Inc.
P.O. Box 746, 13264 Lake Blvd.
Lindstrom, MN 55045
Our File: 6409
Together with all appurtenant rights, title and interests. 038 - 1092 -10 -100
Parcel Identification Number (PIN)
This homestead property
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Dated this 23rd day of January 2007
* // cnn A. Hccht
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) //— _ _— _ — _ STATE OF Wisconsin _ )
- -- — - -.. — -- —.— --. _ ) ss.
P_ olk_ _ County )
authenticated this // — day of //
Personally came before me this _ 2 — day of
—
-— �
SHA - - - M. JACOBSON Januar 2007 the above named
- totaryfabfic - - - -- -- -- - --
State of Wisconsin Kenne A. Becht, a single p erson -
TITLE: MEMBER STATE BAR OF WISCONSIN -
(If not, // _ __ __ to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) e t a know e ed the sa e.
THIS INSTRUMENT WAS DRAFTED BY
J ames S. Casterton, Attorney at Law Shannon M. Jac _
-- - --
13264 Lake Blvd P.O Box 746, Lindstro MN 55045 Notary Public, State of Wis nsin
My Commission is permanent. (I to expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) 3/28/1 0 )
* Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO (soo)655 -2021 www.fnfoprorom,x.com
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. I - 2000
File No.: 6409
SCHEDULE C
LEGAL DESCRIPTION
All that portion of: Southwest Quarter of the Northwest Quarter (SW1 /4 of NWI /4) of Section Twenty -
two (22), Township Thirty -one (31) North, Range Eighteen (18) West, lying to the West of that certain
public highway running in a general Northerly and Southerly direction and intersecting the said SW 1 A
of the NWl /4 of Section 22, Township 31 North, Range 18 West EXCEPT a part of the SW1/4 of the
NW1 /4 of Section 22, Township 31 North, Range 18 West described as follows: Commencing at the SW
corner of said SW1 /4 of the NWI /4 of Section 22; thence East along the South line of SW1 /4 of the
NW1 /4 to the Center line of Town Road transversing said forty acre tract; thence Northeasterly along
the center line of said Town Road a distance of 700 feet; thence directly West to the West line of said
SW1 /4 of the NW1 /4; thence South along the West line of said SW1 /4 of the NW1 /4 to the point of
beginning; AND EXCEPT Lot 1 of Certified Survey Map filed June 19, 1975 in Volume I on page 141
as Document No. 327659; AND EXCEPT Lot 2 of Certified Survey Map recorded in Volume 14 on page
3969, St. Croix County, Wisconsin.
-4-
R ECE I VED
NOR 0*0%W
wiscoriiiia Department ofComme SOIL EVALUATION REPORT Page of Z
DivWm of Safety and Buildings II ((�� j
in a�k� s with Comm , Wis. Adm. Code
Attach complete site plan on pa ST. CROIX COUNTY 1 lze. Plan must County
include, but not limited to: verti cal � ZW2 direction and
Parcel l.D. _
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information I Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
q , Govt. LotsW 1/4 tJ 1/4 S 22T, �� �N R E (oj W
f oparty Owner's Mailing Address Lot # I Block # I Subd. Name or CSM#
S
Cq State Zip Code Phone Number ❑ O�( n [� Village ❑ Town Nearest q ad
-/
❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD
Replacement ❑ Public or commercial - Describe:
Parent matbrial Flood Plain elevation if applicable ft
General comments
and recommendations: :L (��— ��-- `.^ ^•�
a
Boring # Boring
,^
pit Ground surface elev. ft. Depth to limiting factor L J 1 in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - Efi1#1 - 011#2
-22 io 3/ S n•, e. m l, l
z "� n= ' I ' S I ✓ti 1
F2- � 3 o t► I� ny 6 S X75 • 1 �. S ' �- �,
] Bodng# ❑ Boring
Pit Ground surface eiev. ft. Depth to limiting factor 4 >t ' in.
Soil Application Rate
Horizon - Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IP
in. Munsell Qu. Sz. ° °Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2
Z o
- Effluent #1 = BOD > 30 1220 mg/L and TSS >30 150 - uent #2 = BOD 5 30 mg/L and TSS < 30 mg/L
N ame (Ple _ tgn furs — CST Number
f �0 � , - v 5339 V
Address ate Evaluation Co Telephone Number
-Z133 .
Property Owner 7 s < <� � Parcel ID # Z 2 ' 31 / 4 - / Page of
a Boring # E] Boring
>' Pit Ground surface elev. ft. Depth to limiting factor ' � in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnicture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
c - zZ 0 y2 31Y
4
f
,F� Boring # ❑ Boring
❑ Pit Ground surface elev. R Depth to limiting factor in. Soil Appli cation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Efr#1 'Eff#2
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting fador in.
Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BOD > 30 1220 mglL and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mgA- and TSS < 30 mglL
The Depa#mmt efGemmem is an equal opportunity service provide, and empiuyez. if you need assistance to twuess sarvicim or
need material in &i alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
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State of Wisconsin 1 DEPARTMENT OF NATURAL RESOURCES
Jim Doyle, Governor
Baldwin Service Center Scott Hassett, Secretary 890 Spruce Street Baldwin, Wisconsin 54002
WISCONSIN Scott Humrickhouse, Regional Director Telephone 715 - 684 -2914
DEPT. OF NATURAL RESOURCES FAX 715 - 684 -5940
March 28, 2008
Allen Kralewski
3148 85 Street
Frederic, WI 54837
Re: Ordinary High Water Mark Determination for back water ponds of the Apple River Town of
Star Prairie, St. Croix County, also described as being in the SW /NW quarter, west of the Hwy.
In Section 22, T31 N, R1 8W, 2068 & 2070 110' Street
Dear Allen:
The Department has completed our evaluation of the Ordinary High Water Mark survey
(OHWM) for the ponds, as described above. The Bench Mark is a rail road spike located 1 foot
above grade on the east side of a 12" DBH triple trunk red oak tree, 40' south of the lot line, 40'
west of the center line of 110 Street and 20' northeast of the pond. The OHWM is at 94.43 feet
referenced to the above benchmark.
The reason for this determination request is because you wish to subdivide this parcel; which
would entail constructing a new driveway along the northern shoreline in order to access the
newly created lot. The amount of land you own along this shoreline is quite narrow in width,
which in turn makes your driveway location very close to the water's edge. Stabilizing the
shoreline would probably be necessary prior to any grading activities. Please be advised, the
shoreline has the presence of a wetland seep; observed by open water conditions noted during
our inspection.
The Department of Natural Resources would like to promote practical alternatives for wetland
filling. In this particular instance, there is an existing driveway which could be used to access the
proposed lot. It is our preliminary determination that water quality certification would not be
granted for a permit to fill the shoreline /wetland. If the project could be completed with out
stabilizing the bank, there are still space limitations, along with tree cutting and vegetation
removal near the shoreline which is protected by the St. Croix County Shoreland Ordinance.
Please contact me if you have any questions concerning this determination.
Sincerely,
Carrie Stoltz
Water Management Specialist
/cs
Cc: Bob Baczynski, Water Basin Leader, WDNR via email
Kevin Grabau, Code Administrator, St. Croix County Zoning via email
Jenny Shillcox, Zoning Specialist, St. Croix County Zoning via email
Alex Blackburn, Zoning Specialist, St. Croix County Zoning via email
www.dnr.state.wi.us Quality Natural Resources Management
wWW.wisconsin.gov Through Excellent Customer Service Printed on
Recycled
Peoer
Parcel #: 038- 1092-10 -100 03/18/2011 03:56 PM
PAGE 1 OF 1
Alt. Parcel #: 22.31.18.379A -10 038 - TOWN OF STAR PRAIRIE
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
ALLEN L KRALEWSKI O - KRALEWSKI, ALLEN L
3148 85TH ST
FREDERIC WI 54837
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description * 2068 110TH ST
SC 3962 SCH DIST NEW RICHMOND 2070 110TH ST
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE
SEC 22 T31 N R1 8W SW NW W OF HWY EXC Block /Condo Bldg:
P379C & D & EXC CSM IN VOL I P141 EXC
CSM 14/3969 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
22-31N-18W
Notes: Parcel History:
Date Doc # Vol /Page Type
01/29/2007 843403 WD
06/05/2000 624257 1516/330 PR
11/08/1999 613417 1469/23 TI
2011 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/12/2008
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 30,000 69,900 99,900 NO
UNDEVELOPED G5 7.000 7,000 0 7,000 NO
PRODUCTIVE FORST LANDS G6 5.000 25,000 0 25,000 NO
Totals for 2011:
General Property 13.000 62,000 69,900 131,900
Woodland 0.000 0 0
Totals for 2010:
General Property 13.000 62,000 69,900 131,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #: 124
Specials:
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Special Assessments Special Charges Delinquent Charges
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Federal Emergency Management Agenc RECEIV]O
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Washington, D.C. 20472
9 ]VD SE JUL 22 ST. C;RUIX March 13 , 2008 PLANNING & ZON N
MR. ALLEN KRALEWSKI CASE NO.: 08- 05 -2138A
3148 85TH AVENUE COMMUNITY: ST. CROIX COUNTY, WISCONSIN
FREDERIC, WI 54837 (UNINCORPORATED AREAS)
COMMUNITY NO.: 555578
DEAR MR. KRALEWSKI:
This is in reference to a request that the. Federal Emergency Management Agency (FEMA) determine
if the property described in the enclosed document is located within an identified Special Flood
Hazard Area, the area that would be inundated by the flood having a 1- percent chance of being equaled
or exceeded in any given year (base flood), on the effective National Flood Insurance Program (NFIP)
map. Using the information submitted and the effective NFIP map, our determination is shown on the
attached Letter of Map Amendment (LOMA) Determination Document. This determination document
provides additional information regarding the effective NFIP map, the legal description of the
property and our determination.
Additional documents are enclosed which provide information regarding the subject property and
LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. Other
attachments specific to this request may be included as referenced in the Determination/Comment
document. If you have any questions about this le any of the enclosures, please contact the
FEMA Map Assistance Center toll free a 877) 336 -262 877 -FEMA MAP) or by letter addressed
to the Federal Emergency Management Agency, 3601 Eisenhower Avenue, Suite 130, Alexandria, VA
22304 -6439. e�
44 a6z�
Tet K -1—r->
Sincerely, .
William R. Blanton Jr., CFM, Chief
Engineering Management Branch
Mitigation Directorate
LIST OF ENCLOSURES:
LOMA DETERMINATION DOCUMENT (REMOVAL)
cc: State /Commonwealth NFIP Coordinator
Community Map Repository
Region
B —This section must be completed by a registered professional engineer or licensed land surveyor.
NOTE: If the request is to remove the structure, and an Elevation Certificate has been completed for this property, it may be submitted in
lieu of Section B. If the request is to remove the entire legally recorded property, or a portion thereof, the lowest elevation on the lot or
described portion must be provided in Section B.
Applicable Regulations
The regulations pertaining to LOMAs are presented in the National Flood Insurance Program (NFIP) regulations under Title 44, Chapter I, Parts 70 and
72, Code of Federal Regulations. The purpose of Part 70 is to provide an administrative procedure whereby DHS -FEMA will review information submitted
by an owner or lessee of property who believes that his or her property has been inadvertently included in a designated SFHA. The necessity of Part 70 is
due in part to the technical difficulty of accurately delineating the SFHA boundary on an NFIP map. Part 70 procedures shall not apply if the topography
has been altered to raise the original ground to or above the BFE since the effective date of the first NFIP map [e.g., a Flood Insurance Rate Map (FIRM)
or Flood Hazard Boundary Map (FHBM)J showing the property to be within the SFHA.
Basis of Determination
DHS- FEMA's determination as to whether a structure or legally recorded parcel of land, or portions thereof, described by metes and bounds, may be
removed from the SFHA will be based upon a comparison of the Base (1 %- annual- chance) Flood Elevation (BFE) with certain elevation information. For
Zone A, with no BFE determined, refer to Managing Floodplain Development in Approximate Zone A Areas, A Guide for Obtaining and Developing Base
(100 -Year) Flood Elevations. The elevation information required is dependent on whether a structure, or a legally recorded parcel of land, is to be
removed from the SFHA.
Item to be Removed from the SFHA: check one Elevation Information Required: (comp lete Item 5
❑ Structure located on natural grade (LOMA) Lowest Adjacent Grade to the structure (the elevation of the lowest
ground touching the structure including attached decks or garage)
® Legally recorded parcel of land, or portion thereof (LOMA) Elevation of the lowest ground on the parcel or within the portion of land
to be removed from the SFHA
1. PROPERTY DESCRIPTION (Lot and Block Number, Tax Parcel Number, Legal Description, etc.):
PIN 038 - 1092 -10 -100 Property recoded at the St Croix Co. Register of Deeds Office as document #843403 (Warranty Deed attached
2. BUILDING INFORMATION
Building Street Address (including Apt. Unit, Suite, and /or Bldg. No.):
2068- 110ST, New Richmond, Wisconsin 54017
What is the type of construction? (check one) ❑ crawl space ❑ slab on grade ❑ basement/enclosure
❑ other (explain)
3. GEOGRAPHIC COORDINATE DATA
Please provide the Latitude and Longitude of the most upstream edge of the structure (in decimal degrees)
Indicate Datum: ❑ NAD83 ❑ NAD27 Lat. Long.
Please provide the Latitude and Longitude of the most upstream edge of the property (in decimal degrees)
Indicate Datum: ® NAD83 ❑ NAD27 45.16214303 Lat. 92..58520786 Long.
4. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
NFIP Community Number. Map & Panel Number. Base Flood Elevation (BFE): 7F, ce of BFE:
555578B H&108 965 Ma
5. ELEVATION INFORMATION (SURVEY REQUIRED)
• Lowest Adjacent Grade (LAG) to the structure (to the nearest 0.1 foot or meter) ft. (m)
• Elevation of the lowest grade on the property; or metes and bounds area (to the nearest 0.1 foot or meter) 966..0 ft. (m)
• Indicate the datum (and datum conversion if different from NGVD 29 or NAVD 88) ❑ NGVD 29 ® NAVD 88 Other (Describe):
• Has FEMA identified this area as subject to land subsidence or uplift? ® No ❑ Yes (provide date of current releveling) a
This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or architect authorized by law to certify elevation
information. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be ,
punishable by fine or imprisonment under Title 18 of the United States Code, Section 1001. -ei ttiliffr om- lr
Certifier's Name: License No.: Expiration Date: 0�' "�.� �►*�
Clarence E. Schultz Wisconsin S -2031 February 2010
Company Name: Telephone No.: Fax No.:
JEO Consultin2 Group, Inc. 715- 246-43 9 715- 246 -3830 v : S� TZ A
Signatu Date: 31
2- 15-2008 " gS� Hurt", W 1
(See attached address listing for LOMAs)
DHS - FEMA Form 81 -92, SEP 07 MT -EZ Form ����� �l�of 3
Page 2 of 2
Date: March 13, 2008 Case No.: 08- 05 -2138A LOMA
O
-T R Federal Emergency Management Agency
^' o Washington, D.C. 20472
�g1VD 5
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS)
LEGAL PROPERTY DESCRIPTION (CONTINUED)
COMMENCING at the Northwest corner of Section 22; thence S00 °05'07 "E, 1768.95 feet; thence N78 °17'48 "E,
331.68 feet; thence N89 °22'10 "E, 321.98 feet; thence N00 °04'16 "W, 50.00 feet to the POINT OF BEGINNING;
thence N00 °04'16 "W, 339.49 feet; thence N89 0 28'06 "E, 385.00 feet; thence S51 0 23'36 "W, 135.00 feet; thence
S32 °06'45 "W, 110.00 feet; thence S38 °39'32 "W, 110.00 feet; thence S31'37'1 1 "E, 30.00 feet; thence
N78 0 41'28 "E, 25.00 feet; thence S06 °15'18 "E, 180.00 feet; thence S49 °43'03 "W, 90.00 feet; thence
N35 °15'00 "W, 85.00 feet; thence N13 0 51'07 "W, 70.00 feet; thence N46 0 27'51 "W, 40.00 feet; thence
N74 0 50'36 "W, 50.00 feet to the POINT OF BEGINNING.
PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the
preceding 1 Property.)
Portions of this property, but not the subject of the Determination /Comment document, may remain in the Special
Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains
subject to Federal, State /Commonwealth, and local regulations for floodplain management.
STUDY UNDERWAY (This Additional Consideration applies to all properties in the LOMA
DETERMINATION DOCUMENT (REMOVAL))
This determination is based on the flood data presently available. However, the Federal Emergency
Management Agency is currently revising the National Flood Insurance Program (NFIP) map for the community.
New flood data could be generated that may affect this property. When the new NFIP map is issued it will
supersede this determination. The Federal requirement for the purchase of flood insurance will then be based on
the newly revised NFIP map.
STATE AND LOCAL CONSIDERATIONS (This Additional Consideration applies to all properties in the
LOMA DETERMINATION DOCUMENT (REMOVAL))
Please note that this document does not override or supersede any State or local procedural or substantive
provisions which may apply to floodplain management requirements associated with amendments to State or
local floodplain zoning ordinances, maps, or State or local procedures adopted under the National Flood
Insurance Program.
This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the
FEMA Map Assistance Center toll free at (877) 336 -2627 (877 -FEMA MAP) or by letter addressed to the Federal Emergency Management
Agency, 3601 Eisenhower Avenue, Suite 130, Alexandria, VA 22304- 6y4�399. p
(/!/ ' 1
William R. Blanton Jr., CFM, Chief
Engineering Management Branch
Mitigation Directorate
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